Kernicterus in Preterm Infants; Lest We Forget (To Turn on the Lights)

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 757-759
Author(s):  
N. KEVIN IVES
Keyword(s):  
Intensive Care ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Neonatal Jaundice ◽  
Current Issue ◽  
Historical Review ◽  
Term Infants ◽  
Turn On ◽  
Treatment Thresholds ◽  
One Act

Watchko and Oski have a reputation for stimulating debate on the topic of neonatal jaundice. As scriptwriters of "Vigintiphobia: a one-act play,"1 they questioned the `standard practice' applied to the management of jaundice in otherwise healthy term infants. In the current issue of Pediatrics2 they again court controversy by turning their attention to treatment thresholds and the risk of kernicterus in jaundiced preterm infants. We are provided with a thoroughly researched historical review of the risk of kernicterus in the preterm infant from 1950 to the 1990s. The story is presented as a journey of experience from the pre-intensive care era, through the so-called `low bilirubin kernicterus era' (1965 through 1982), to the present.

Gut microbiota development of preterm infants hospitalised in intensive care units

2019 ◽  
Vol 10 (6) ◽  
pp. 641-651 ◽  
Author(s):  
H. Tauchi ◽  
K. Yahagi ◽  
T. Yamauchi ◽  
T. Hara ◽  
R. Yamaoka ◽  
...  
Keyword(s):  
Intensive Care ◽  
Individual Differences ◽  
Gut Microbiota ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Infant Health ◽  
Rrna Gene ◽  
Term Infants ◽  
Gut Microbe

Gut microbiome development affects infant health and postnatal physiology. The gut microbe assemblages of preterm infants have been reported to be different from that of healthy term infants. However, the patterns of ecosystem development and inter-individual differences remain poorly understood. We investigated hospitalised preterm infant gut microbiota development using 16S rRNA gene amplicons and the metabolic profiles of 268 stool samples obtained from 17 intensive care and 42 term infants to elucidate the dynamics and equilibria of the developing microbiota. Infant gut microbiota were predominated by Gram-positive cocci, Enterobacteriaceae or Bifidobacteriaceae, which showed sequential transitions to Bifidobacteriaceae-dominated microbiota. In neonatal intensive care unit preterm infants (NICU preterm infants), Staphylococcaceae abundance was higher immediately after birth than in healthy term infants, and Bifidobacteriaceae colonisation tended to be delayed. No specific NICU-cared infant enterotype-like cluster was observed, suggesting that the constrained environment only affected the pace of transition, but not infant gut microbiota equilibrium. Moreover, infants with Bifidobacteriaceae-dominated microbiota showed higher acetate concentrations and lower pH, which have been associated with host health. Our data provides an in-depth understanding of gut microbiota development in NICU preterm infants and complements earlier studies. Understanding the patterns and inter-individual differences of the preterm infant gut ecosystem is the first step towards controlling the risk of diseases in premature infants by targeting intestinal microbiota.

scholarly journals Does birth weight affect neonatal body weight, growth, and physiology in an animal model?

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246954
Author(s):  
Khaled Adjerid ◽  
Christopher J. Mayerl ◽  
Francois D. H. Gould ◽  
Chloe E. Edmonds ◽  
Bethany M. Stricklen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Strong Predictor ◽  
Low Birth Weight Infants ◽  
Term Infants ◽  
Functional Deficits ◽  
Weight Growth ◽  
Infant Birth

Infant birth weight affects neuromotor and biomechanical swallowing performance in infant pig models. Preterm infants are generally born low birth weight and suffer from delayed development and neuromotor deficits. These deficits include critical life skills such as swallowing and breathing. It is unclear whether these neuromotor and biomechanical deficits are a result of low birth weight or preterm birth. In this study we ask: are preterm infants simply low birth weight infants or do preterm infants differ from term infants in weight gain and swallowing behaviors independent of birth weight? We use a validated infant pig model to show that preterm and term infants gain weight differently and that birth weight is not a strong predictor of functional deficits in preterm infant swallowing. We found that preterm infants gained weight at a faster rate than term infants and with nearly three times the variation. Additionally, we found that the number of sucks per swallow, swallow duration, and the delay of the swallows relative to the suck cycles were not impacted by birth weight. These results suggest that any correlation of developmental or swallowing deficits with reduced birth weight are likely linked to underlying physiological immaturity of the preterm infant.

Auditory Brainstem Response in Preterm Infants in the Neonatal Intensive Care Unit

2020 ◽  
pp. 019459982095518
Author(s):  
Diogo Raposo ◽  
João Orfão ◽  
Marco Menezes ◽  
Mafalda Trindade-Soares ◽  
Ana Guimarães ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Preterm Infants ◽  
Auditory Brainstem Response ◽  
Neonatal Intensive Care ◽  
Auditory Brainstem ◽  
Term Infants ◽  
Congenital Cytomegalovirus ◽  
Brainstem Response

Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

87 Validation of a Costing Algorithm in the Neonatal Intensive Care Unit and Identification of Cost Drivers for Neonates

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e62-e64
Author(s):  
Elias Jabbour ◽  
Sharina Patel ◽  
Juan David Rios ◽  
Petros Pechlivanoglou ◽  
Prakesh Shah ◽  
...  
Keyword(s):  
Intensive Care ◽  
Real Time ◽  
Preterm Infants ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Case Mix ◽  
P Value ◽  
Term Infants ◽  
Time Costs ◽  
Financial Software

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Neonatal Intensive Care Units (NICUs) account for over 35% of pediatric in-hospital clinical costs, thus implying that a better understanding of care expenditures within these units is the first step for improving efficiency of care. The Canadian Neonatal Network (CNN) algorithm is the first to provide case-specific costs based on resource usage among preterm infants born < 37 weeks but has not yet been validated for other populations in the NICU. Objectives To validate the CNN costing algorithm in six case-mix categories with real-time costs obtained from hospital-specific financial software (CPSS) in a tertiary-level NICU and assess the variations in proportion of cost centers across case-mixes. Design/Methods A retrospective cohort study of all patients admitted within 24h of birth to a Level 3 medico-surgical NICU 2016-2019. Patient demographics, clinical information and CNN predicted costs were obtained from the CNN database. Real-time costs were obtained from the hospital financial software (CPSS). Total and daily costs were compared between sources using Pearson correlation coefficient (r) and paired Student’s t-test. Costs were adjusted to account for inter-institutional and -provincial price variations using the Cost of Standard Hospitalization Stay from the Canadian Institute for Health Information. Proportions of each cost center across the different case-mix categories were compared using Chi-square analyses. Results Among the 1795 live infants admitted into the NICU, 167 (9.3%) were < 29 weeks gestational age (GA), 193 (11%) were 29-32 weeks GA, 457 (25.5%) were 33-36 weeks GA, 144 (8%) had major congenital anomalies, 179 (10%) were term infants diagnosed with Hypoxic-Ischemic Encephalopathy (HIE) and 672 (37%) were term infants with no HIE or major congenital anomalies. Median NICU costs varied according to each case-mix from $10,025 for term infants without HIE or congenital anomaly to $180,145 for infants born < 29 weeks (Figure 1). Despite high variation in total NICU costs, there were small variations in median daily costs (range: $1,312-$1,941). Overall, the CNN algorithm strongly correlated with CPSS total costs across all 6 case-mix categories (r range 0.90-1.00, p-value < 0 .01) (Figure 2). We report a consistent strong predictive performance of the algorithm in 5/8 pre-specified cost centers among preterm infants (r range 0.77-0.99, p-value < 0 .01). Unit producing personnel (nurses and physicians) consistently comprised the largest proportion of total costs (64-78%) for all case-mix categories. Conclusion The CNN algorithm accurately predicts NICU total costs for six case-mix categories. Costs per day were comparable across different case-mix categories, and unit producing personnel represented the highest proportion of costs suggesting that reductions in length of stay would be the most efficient method to reduce NICU costs.

Kangaroo Baby Care: Just a Nice Experience or an Important Advance for Preterm Infants?

PEDIATRICS ◽  
1990 ◽  
Vol 85 (4) ◽  
pp. 604-605
Author(s):  
ANDREW WHITELAW
Keyword(s):  
Intensive Care ◽  
Home Care ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Developed Countries ◽  
Important Advance ◽  
Skin Contact ◽  
Skin To Skin

"Kangaroo baby care" or "skin-to-skin contact" describes the practice of holding a preterm infant naked (except for a diaper) between the mother's breasts. The baby's face pokes out of the top of the mother's dress like a baby kangaroo's. Rey and Martinez in Bogota, Colombia1 pioneered the home care of premature infants as small as 1000 g, the mother being taught to hold her baby head-up kangaroo-style to encourage lactation, prevent aspiration, and reduce rejection. Education and motivation of the mother in the care of preterm infants makes obvious sense in the developing world, but kangaroo baby care has also been applied in many developed countries in conjunction with neonatal intensive care rather than as a replacement for incubators and monitors.2-4

Brain-Oriented Care in the NICU: A Case Study

2014 ◽  
Vol 33 (5) ◽  
pp. 263-267 ◽  
Author(s):  
Lisa Bader
Keyword(s):  
Preterm Infant ◽  
Preterm Infants ◽  
Premature Infants ◽  
Normal Development ◽  
Developmental Outcome ◽  
Medical Field ◽  
Term Infants ◽  
Developmental Care ◽  
The Brain

With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development—it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside.

scholarly journals INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e28-e28 ◽  
Author(s):  
Thivia Jegathesan ◽  
Michael Sgro ◽  
Vibhuti Shah ◽  
Aidan Campbell ◽  
Douglas Campbell
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Term Infants ◽  
Treatment Thresholds ◽  
Weight Outcomes ◽  
The Mean ◽  
Current Guidelines

Abstract BACKGROUND Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants. OBJECTIVES The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants. DESIGN/METHODS A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups. RESULTS A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age. CONCLUSION Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.

scholarly journals A Handy Preterm Infant Incubator for Providing Intensive Care: Simulation, 3D Printed Prototype, and Evaluation

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Amira J. Zaylaa ◽  
Mohamad Rashid ◽  
Mounir Shaib ◽  
Imad El Majzoub
Keyword(s):  
Intensive Care ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Low Income ◽  
Kangaroo Mother Care ◽  
Low Income Countries ◽  
Original Research ◽  
Infant Incubator ◽  
3D Printed ◽  
Overall Performance

Preterm infants encounter an abrupt delivery before their complete maturity during the third trimester of pregnancy. Polls anticipate an increase in the rates of preterm infants for 2025, especially in middle- and low-income countries. Despite the abundance of intensive care methods for preterm infants, such as, but not limited to, commercial, transport, embrace warmer, radiant warmer, and Kangaroo Mother Care methods, they are either expensive, lack the most essential requirements or specifications, or lack the maternal-preterm bond. This drove us to carry this original research and innovative idea of developing a new 3D printed prototype of a Handy preterm infant incubator. We aim to provide the most indispensable intensive care with the lowest cost, to bestow low-income countries with the Handy incubator’s care, preserve the maternal -preterm’s bond, and diminish the rate of mortality. Biomedical features, electronics, and biocompatible materials were utilized. The design was simulated, the prototype was 3D printed, and the outcomes were tested and evaluated. Simulation results showed the best fit for the Handy incubator’s components. Experimental results showed the 3D-printed prototype and the time elapsed to obtain it. Evaluation results revealed that the overall performance of Kangaroo Mother Care and the embrace warmer was 75 ± 1.4% and 66.7 ± 1.5%, respectively, while the overall performance of our Handy incubator was 91.7 ± 1.6%, thereby our cost-effective Handy incubator surpassed existing intensive care methods. The future step is associating the Handy incubator with more specifications and advancements.

Premature Infant Massage in the NICU

2003 ◽  
Vol 22 (3) ◽  
pp. 39-45 ◽  
Author(s):  
Jodi Beachy
Keyword(s):  
Intensive Care ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Care Setting ◽  
Massage Therapy ◽  
Intensive Care Setting ◽  
Parenting Skills ◽  
Infant Massage ◽  
Developmental Care

Infant massage therapy is an inexpensive tool that should be utilized as part of the developmental care of the preterm infant. Nurses have been hesitant to begin massage therapy for fear of overstimulating the infant and because there has been insufficient research to prove its safety. Recent research, however, has shown that the significant benefits of infant massage therapy far outweigh the minimal risks. When infant massage therapy is properly applied to preterm infants, they respond with increased weight gains, improved developmental scores, and earlier discharge from the hospital. Parents of the preterm infant also benefit because infant massage enhances bonding with their child and increases confidence in their parenting skills. This article discusses the benefits and risks of massage for preterm infants and their families and explains how to implement massage therapy in the neonatal intensive care setting.

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